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The impact of comorbid disease history on all-cause and cancer-specific mortality in myeloid leukemia and myeloma - a Swedish population-based study.

Mohammadi M, Cao Y, Glimelius I, Bottai M, Eloranta S, Smedby KE - BMC Cancer (2015)

Bottom Line: Comorbidity was associated with increased all-cause as well as cancer-specific mortality (cancer-specific MRR: AML = 1.27, 95 % CI: 1.15-1.40; CML = 1.28, 0.96-1.70; myeloma = 1.17, 1.08-1.28) compared with patients without comorbidity.The difference in the probability of cancer-specific death, comparing patients with and without comorbidity, was largest among AML patients <70 years, whereas in myeloma the difference did not vary by age among the elderly.The results highlight the need for a better balance between treatment toxicity and efficacy in comorbid and elderly AML, CML and myeloma patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. mohammad.mohammadi@ki.se.

ABSTRACT

Background: Comorbidity increases overall mortality in patients diagnosed with hematological malignancies. The impact of comorbidity on cancer-specific mortality, taking competing risks into account, has not been evaluated.

Methods: Using the Swedish Cancer Register, we identified patients aged >18 years with a first diagnosis of acute myeloid leukemia (AML, N = 2,550), chronic myeloid leukemia (CML, N = 1,000) or myeloma (N = 4,584) 2002-2009. Comorbid disease history was assessed through in- and out-patient care as defined in the Charlson comorbidity index. Mortality rate ratios (MRR) were estimated through 2012 using Poisson regression. Probabilities of cancer-specific death were computed using flexible parametric survival models.

Results: Comorbidity was associated with increased all-cause as well as cancer-specific mortality (cancer-specific MRR: AML = 1.27, 95 % CI: 1.15-1.40; CML = 1.28, 0.96-1.70; myeloma = 1.17, 1.08-1.28) compared with patients without comorbidity. Disorders associated with higher cancer-specific mortality were renal disease (in patients with AML, CML and myeloma), cerebrovascular conditions, dementia, psychiatric disease (AML, myeloma), liver and rheumatic disease (AML), cardiovascular and pulmonary disease (myeloma). The difference in the probability of cancer-specific death, comparing patients with and without comorbidity, was largest among AML patients <70 years, whereas in myeloma the difference did not vary by age among the elderly. The probability of cancer-specific death was generally higher than other-cause death even in older age groups, irrespective of comorbidity.

Conclusion: Comorbidities associated with organ failure or cognitive function are associated with poorer prognosis in several hematological malignancies, likely due to lower treatment tolerability. The results highlight the need for a better balance between treatment toxicity and efficacy in comorbid and elderly AML, CML and myeloma patients.

No MeSH data available.


Related in: MedlinePlus

MRR for all-cause and cancer-specific death by type of comorbid disease. MRR mortality rate ratios adjusted for age (in 10 year intervals), country of birth, time since diagnosis, calendar year of diagnosis and number of comorbid diseases, sex and education level except when main effects of these factors were estimated. AML acute myeloid leukemia, CML chronic myeloid leukemia, CPD, chronic pulmonary disease. *Because of few patients with hemiplegia/paraplegia (n = 49) and HIV/AIDS (n = 2) overall, and with liver disease in CML, results for these groups are not presented
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Fig1: MRR for all-cause and cancer-specific death by type of comorbid disease. MRR mortality rate ratios adjusted for age (in 10 year intervals), country of birth, time since diagnosis, calendar year of diagnosis and number of comorbid diseases, sex and education level except when main effects of these factors were estimated. AML acute myeloid leukemia, CML chronic myeloid leukemia, CPD, chronic pulmonary disease. *Because of few patients with hemiplegia/paraplegia (n = 49) and HIV/AIDS (n = 2) overall, and with liver disease in CML, results for these groups are not presented

Mentions: A higher all-cause as well as cancer-specific mortality in AML was observed for patients with previous cerebrovascular disease, rheumatologic diseases, renal disease, liver disease and psychiatric disease (Fig. 1). Dementia was also significantly associated with AML-specific mortality. Renal disorders were associated with the highest increase in mortality (MRR all-cause death = 3.10, 95 % CI: 1.96–4.89; MRR AML-specific death =2.46, 1.41–4.27, Fig. 1). Two-hundred and fourteen AML patients (8.3 %) had a prior record of MDS/MPN (MDS = 137, MPN = 77). Adjustment for previous MDS/MPN did not meaningfully alter the associations between non-hematological comorbidities and cancer-specific mortality. To address the relative contribution of prior cancer treatment, we also analyzed outcomes in association with non-malignant comorbidities separately, and results remained virtually unchanged.Fig. 1


The impact of comorbid disease history on all-cause and cancer-specific mortality in myeloid leukemia and myeloma - a Swedish population-based study.

Mohammadi M, Cao Y, Glimelius I, Bottai M, Eloranta S, Smedby KE - BMC Cancer (2015)

MRR for all-cause and cancer-specific death by type of comorbid disease. MRR mortality rate ratios adjusted for age (in 10 year intervals), country of birth, time since diagnosis, calendar year of diagnosis and number of comorbid diseases, sex and education level except when main effects of these factors were estimated. AML acute myeloid leukemia, CML chronic myeloid leukemia, CPD, chronic pulmonary disease. *Because of few patients with hemiplegia/paraplegia (n = 49) and HIV/AIDS (n = 2) overall, and with liver disease in CML, results for these groups are not presented
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4634819&req=5

Fig1: MRR for all-cause and cancer-specific death by type of comorbid disease. MRR mortality rate ratios adjusted for age (in 10 year intervals), country of birth, time since diagnosis, calendar year of diagnosis and number of comorbid diseases, sex and education level except when main effects of these factors were estimated. AML acute myeloid leukemia, CML chronic myeloid leukemia, CPD, chronic pulmonary disease. *Because of few patients with hemiplegia/paraplegia (n = 49) and HIV/AIDS (n = 2) overall, and with liver disease in CML, results for these groups are not presented
Mentions: A higher all-cause as well as cancer-specific mortality in AML was observed for patients with previous cerebrovascular disease, rheumatologic diseases, renal disease, liver disease and psychiatric disease (Fig. 1). Dementia was also significantly associated with AML-specific mortality. Renal disorders were associated with the highest increase in mortality (MRR all-cause death = 3.10, 95 % CI: 1.96–4.89; MRR AML-specific death =2.46, 1.41–4.27, Fig. 1). Two-hundred and fourteen AML patients (8.3 %) had a prior record of MDS/MPN (MDS = 137, MPN = 77). Adjustment for previous MDS/MPN did not meaningfully alter the associations between non-hematological comorbidities and cancer-specific mortality. To address the relative contribution of prior cancer treatment, we also analyzed outcomes in association with non-malignant comorbidities separately, and results remained virtually unchanged.Fig. 1

Bottom Line: Comorbidity was associated with increased all-cause as well as cancer-specific mortality (cancer-specific MRR: AML = 1.27, 95 % CI: 1.15-1.40; CML = 1.28, 0.96-1.70; myeloma = 1.17, 1.08-1.28) compared with patients without comorbidity.The difference in the probability of cancer-specific death, comparing patients with and without comorbidity, was largest among AML patients <70 years, whereas in myeloma the difference did not vary by age among the elderly.The results highlight the need for a better balance between treatment toxicity and efficacy in comorbid and elderly AML, CML and myeloma patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. mohammad.mohammadi@ki.se.

ABSTRACT

Background: Comorbidity increases overall mortality in patients diagnosed with hematological malignancies. The impact of comorbidity on cancer-specific mortality, taking competing risks into account, has not been evaluated.

Methods: Using the Swedish Cancer Register, we identified patients aged >18 years with a first diagnosis of acute myeloid leukemia (AML, N = 2,550), chronic myeloid leukemia (CML, N = 1,000) or myeloma (N = 4,584) 2002-2009. Comorbid disease history was assessed through in- and out-patient care as defined in the Charlson comorbidity index. Mortality rate ratios (MRR) were estimated through 2012 using Poisson regression. Probabilities of cancer-specific death were computed using flexible parametric survival models.

Results: Comorbidity was associated with increased all-cause as well as cancer-specific mortality (cancer-specific MRR: AML = 1.27, 95 % CI: 1.15-1.40; CML = 1.28, 0.96-1.70; myeloma = 1.17, 1.08-1.28) compared with patients without comorbidity. Disorders associated with higher cancer-specific mortality were renal disease (in patients with AML, CML and myeloma), cerebrovascular conditions, dementia, psychiatric disease (AML, myeloma), liver and rheumatic disease (AML), cardiovascular and pulmonary disease (myeloma). The difference in the probability of cancer-specific death, comparing patients with and without comorbidity, was largest among AML patients <70 years, whereas in myeloma the difference did not vary by age among the elderly. The probability of cancer-specific death was generally higher than other-cause death even in older age groups, irrespective of comorbidity.

Conclusion: Comorbidities associated with organ failure or cognitive function are associated with poorer prognosis in several hematological malignancies, likely due to lower treatment tolerability. The results highlight the need for a better balance between treatment toxicity and efficacy in comorbid and elderly AML, CML and myeloma patients.

No MeSH data available.


Related in: MedlinePlus